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Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study

Published:March 05, 2021DOI:https://doi.org/10.1016/j.ejim.2021.02.017

      Highlights

      • Most infective endocarditis in solid organ transplantation patients are nosocomial
      • Over 70% are health care-related.
      • Half have previously normal heart valves
      • Almost 60% are due to Staphylococcus spp. infections.
      • Mortality seems to be similar to non- solid organ transplantation counterparts

      Abstract

      Background

      Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT.

      Methods

      We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018.

      Results

      We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p<0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p<0.001) and staphylococcal etiology (57.7% vs. 39.7%, p=0.001). Patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1 %, p<0.001), sepsis (27.1% vs. 17.2%, p=0.02), and less surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) than patients without SOT. There were no significant differences in mortality: inhospital (30.6% SOT vs. 25.6% without SOT, p=0.31), 1-year (38.8% SOT vs. 31.9% without SOT, p=0.18).

      Conclusions

      Most IE in SOT recipients are nosocomial and over 70% are health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus spp. infections. Mortality seems to be similar to non-SOT counterparts.

      Keywords

      Abbreviations:

      GAMES (Spanish Collaboration on Endocarditis — Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España), IE (Infective endocarditis), SOT (Solid organ transplantation)
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